Healthcare Provider Details

I. General information

NPI: 1750666434
Provider Name (Legal Business Name): JASON KYLE HONTZ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11314 4TH AVE W STE 103
EVERETT WA
98204-6926
US

IV. Provider business mailing address

55 NW WALL ST STE 100
BEND OR
97703-3200
US

V. Phone/Fax

Practice location:
  • Phone: 425-355-3739
  • Fax: 425-514-8353
Mailing address:
  • Phone: 541-389-4321
  • Fax: 541-389-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH60238068
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: